Continuous positive airway pressure (CPAP)

At the onset of sleep, the tongue and muscles around your throat relax, and this may lead to narrowing of the upper airway. In people with OSA the upper airway can totally collapse, blocking the airway at the back of your throat.

This obstruction in the upper airway will result in an absence of breathing lasting from a few seconds up to a couple of minutes. This period without breathing will cause a reduction to your oxygen levels, which will eventually be detected by your body in order to restart your breathing again. When this process happens repeatedly through the night, it will cause disturbed sleep and put more strain on your major organs. Disturbed or fragmented sleep can cause symptoms such as restlessness and daytime tiredness/sleepiness. If untreated, obstructive sleep apnoea can also lead to further health problems such as heart and blood pressure issues.

CPAP stands for Continuous Positive Airway Pressure and is the treatment for Obstructive Sleep Apnoea.

The CPAP machine will open the airway at the back of your throat during sleep by delivering continual pressurised air through a mask. This pressure stops the narrowing at the back of the throat, thus preventing obstruction and apnoeas. This will then improve airflow into your lungs, increase your blood oxygen levels during the night and reduce sleep disturbance.

By using CPAP therapy to treat OSA, there are several long term health benefits.

The potential benefits of using CPAP include:

• Reduce daytime tiredness
• Stop snoring
• Improve concentration
• Improve mood
• Correct sleep patterns
• Reduce blood pressure
• Reduce risk of heart problems
• Reduce risk of strokes
• Improve metabolism

Modern CPAP machines are equipped with technology to allow information to be accessed remotely. This information includes usage, mask leak and breathing events. This means that we can review your therapy without you coming into the department with your CPAP equipment. The benefit of this is that we can give you advice or change CPAP settings without you having to come into hospital. There may be occasions where we need to see you face to face for an appointment. Please refer to any appointment letters for the type of appointment booked. We will discuss remote monitoring with you on the day of your first appointment, and would need your consent to activate this feature.

Visit 1 - Initiation

On your first appointment a Respiratory Physiologist will briefly explain why you have been referred for a CPAP trial. The Physiologist will then fit you with a suitable mask and explain how to adjust and maintain it. It is very important that the mask fits correctly; this will ensure that the therapy works effectively. You will be shown how to operate the CPAP device.

The length of time that you can use your CPAP machine during the night is patient dependent, however sleep is important and adults are recommended to get 7 to 8 hours sleep per night. We would hope you can use your machine for at least 4 hours a night for it to be beneficial. It can take a few days or weeks to get used to your machine so please persevere and try to use it as much as you can.

Initiation Follow Up

You will be contacted by telephone approximately 1 week after your CPAP initiation appointment for a remote review of your therapy. You will have the opportunity to discuss your therapy and any issues you may have had. Your therapy data will also be reviewed and any necessary changes to settings will be made remotely. We will also contact you by phone approximately one month after your CPAP initiation for a remote review.

Your CPAP machine is on loan to you for as long as you require it. It is usually a long term treatment but please see the tips below regarding how you can help with the condition. You are advised to use the CPAP machine every night for as long as possible whilst you are asleep in order to gain the most benefit from therapy.

Once we are satisfied that your therapy has been optimised, and you are happy and compliant with the therapy, you will be placed onto a Patient Initiated Follow Up (PIFU) pathway.

Patient-initiated follow-up puts you in control of your follow-up care. You have a three year period to contact the service from your CPAP initiation, and then a rolling 3-year period after each review. You will need a review of your CPAP therapy within this three year period, but it is up to you when this is. Reviews can be done either at a face to face appointment or via a telephone consultation. Depending on how your therapy is going, you may be reviewed more frequently to begin with. You will need to bring your CPAP machine and mask to every face to face appointment. During a review we will discuss how your CPAP therapy is progressing and make any adjustments to the pressure if necessary. Consumables (e.g. masks) will also be replaced when necessary

The most common cause of OSA is excessive weight, therefore weight loss is highly recommended. You may find motivation to exercise and lose weight is improved once you are successfully on CPAP therapy. Your weight will be recorded at each visit to CPAP clinic as any significant changed may impact on your CPAP therapy. Sleep studies may be repeated to check for improvements to your condition following weight loss.

In addition to using your CPAP machine, these other tips can help with the condition:

• Stop smoking
• Avoid alcohol
• Avoid certain drugs (sedatives) - ask your clinician if unsure

If you find that you cannot tolerate CPAP, please discuss this with a Respiratory Physiologist as CPAP therapy has proven to be a successful treatment for OSA and reducing its associated health risks. All unused equipment must be returned to the department.

You may encounter some minor problems initially which usually can be overcome quite easily.

Sore or dry eyes

Cause: Mask not positioned properly (air blowing into eyes)
Solution: Reposition and adjust. If this doesn't work, contact the department for re-fitting.

Redness on the face where mask contacts the skin

Cause: Headgear adjusted too tightly or irritation or allergic reaction to the mask.
Solution: Loosen headgear. If this doesn't work, contact the department.

Sneezing or persistent runny nose

Cause: Initial reaction to airflow through the nose.
Solution: Symptoms will ease with continual use. Try anti-inflammatory nasal spray; contact the department for further information.

Still feeling tired during the day

Cause: Mask not fitting properly or pressure too low.
Solution: Re-adjust mask. If this doesn't work, contact the department.

Intolerance of CPAP

Cause: Sleeping with new equipment.
Solution: Persevere and and try to use, CPAP works 

Never run the machine without a filter. The filter should be replaced every 6 months or as necessary, as demonstrated at your initial appointment. Replacement filters can be posted to your home address. Please contact the department if new filters are required or if you require advice on how to replace the filter.

Wipe the mask on a daily basis.

Give the mask and tubing a good clean once a week:

1. Wash the mask and tubing in a mild detergent (disconnect from the machine first)
2. Rinse thoroughly 
3. Dry mask with a soft clean cloth
4. Hang the tubing to dry

Ensure the mask and tubing are completely dry before re-connecting.

Do not use any antibacterial detergents or any detergents with additives such as aloe vera. Mild, fragrance free washing up liquid is recommended.

If you have any problems or queries at all with your CPAP therapy please do not hesitate to contact us, we are here to help answer any questions or problems you may have. Contact us by telephone on 01709 424572 or by email at rgh-tr.sleepservice@nhs.net.

Please do not drop into the department without an appointment as we will be unable to see you if we are seeing other patients. We may also need to order consumables depending on the problem you have. Please call or email to arrange an appointment or request consumables, and we will try and deal with your request as soon as possible. 

If possible, take your CPAP into hospital with you. In most cases you will be able to continue to use your CPAP overnight on the ward.

You can take your CPAP with you wherever you travel. Prior arrangements may need to be made to take your CPAP on certain airlines or ships. In most cases, we can give you a letter confirming the CPAP is a medical device which should allow you to take the machine through airport security without hassle. To use your CPAP during travel, you will need to ensure adequate power supply is available. Please contact the department should you have any questions about travelling with your CPAP.

For current guidance on driving and sleep apnoea, please refer to the DVLA guidelines or contact the department using the contact details in this booklet and ask to speak to a Respiratory Physiologist. You must never drive if you feel excessively tired.

• Sleep Apnoea Trust
• British Lung Foundation
• DVLA guidance on sleep apnoea and driving

Respiratory and Sleep Physiology 

01709 424572 
Monday to Friday, 8.30am to 4.30pm
Email: rgh-tr.medical.physics@nhs.net